Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
@ samaresh
Oxygenation
Oxygenation : Process of adding oxygen to the body system.
o clinical signs alone - Cyanosis, pallor and other physical findings
are not reliable.
concentrations (PO2)
@ samaresh
Acid Base Balance
@ samaresh
Basic Terminology
PH: Free H+ conc. , PH Inversely related to H+
@ samaresh
Why Order an ABG?
o Aids in establishing a diagnosis
@ samaresh
Logistics
• Where to place -- the options
– Radial
– Femoral
– Brachial
– Dorsalis Pedis
@ samaresh
Technical Errors
Air bubbles
o PO2 150 mmHg & PCO2 0 mm Hg in air bubble.
Fever or Hypothermia
o Most ABG analyzers report data at N body temp
o If severe hyper/hypothermia, values of pH & PCO2 at 37 C
can be significantly diff from pt’s actual values
@ samaresh
Acid Base Status
o Assessment via bicarbonate-carbon dioxide buffer
system in blood.
o H+ = 24 × ( Pco2 / HCO3)
o PCO2 / HCo3 identifies the primary acid base disoders
and secondary response
@ samaresh
Sample collection
o Only the person who collect the sample can tell if he has
drawn a pulsating blood
Arterial Venous
Pco2 35- 45 44 - 48
Po2 80 - 100 38 - 42
Hco3 24- 26 20 - 24
@ samaresh
During compensation HCO3¯ &
PaCO2 move in the same
direction
@ samaresh
Compensation
Respiratory compensation
is always FAST …12-24 hrs
Metabolic compensation
• is always SLOW..2- 3
days
@ samaresh
Metabolic acidosis
@ samaresh
Response to Metabolic Acidosis
o Secondary response decrease Pco2 by increase ventilation
o Appears in 30-120 minute & can take 12-24 hrs
o Expected Paco2 = 40 - ( 1.2 × ∆ Hco3)
EXAMPLE:
Metabolic acidosis with a plasma HCO3 of 10 mEq/L,
∆ HCO3 is 24 – 10 = 14 mEq/L,
@ samaresh
Metabolic alkalosis
@ samaresh
Response to Metabolic Alkalosis
o Secondary response : Increase Pco2 by decrease
ventilation
@ samaresh
Response to Respiratory Acidosis
o Secondary response of PaCO2 occurs in the kidneys,
o HCO3 absorption in the proximal tubes
o Response is relatively slow, take 2 or 3 days to reach
completion.
o Because of delay, respiratory acid-base disorders are
separated into acute and chronic disorders.
@ samaresh
Response to Respiratory Alkalosis
EXAMPLE:
@ samaresh
Stepwise approach to
Acid Base analysis
@ samaresh
@ samaresh
Stepwise approach to Acid Base
analysis
o Structured, rule-based approach to the diagnosis of
primary, secondary, and mixed acid-base disorders using
the relationships between the PH, PCO2, and HCO3
Normal Values :
o pH = 7.35–7.45
o PCO2 = 35–45 mm Hg
@ samaresh
Stepwise approach to Acid Base
analysis
o Stage I: PaCO2 and pH are used to identify the primary acid-
base disorder.
o Rule 1: If PaCO2 and/or the pH is outside the normal range,
there is an acid-base disorder.
o Rule 2: If PaCO2 and pH both abnormal, compare the
directional change.
@ samaresh
Stepwise approach to Acid Base
analysis
Rule 3: If only pH or PaCO2 is abnormal, the condition is mixed
metabolic and respiratory disorder
o 3a. If PaCO2 is abnormal, the directional change in PaCO2
identifies the type of respiratory disorder (e.g., high PaCO2
indicates a respiratory acidosis), and the opposing metabolic
disorder.
o 3b. If the pH is abnormal, the directional change in pH
identifies the type of metabolic disorder (e.g., low pH
indicates a metabolic acidosis) and the opposing respiratory
disorder
@ samaresh
Stepwise approach to Acid Base
analysis
EXAMPLE:
@ samaresh
Stepwise approach to Acid Base
analysis
EXAMPLE:
o PaCO2 = 23 mm Hg, the pH = 7.32, and the HCO3 = 16 mEq/L. The
pH and PCO2 change in the same direction, indicating a primary
metabolic disorder, and the pH is acidemic, so the disorder is a
primary metabolic acidosis.
Respiratory
compensation
is always FAST …12-24
hrs
Metabolic compensation
• is always SLOW..2- 3
days
@ samaresh
Stepwise approach to Acid Base
analysis
o Rule 6: Primary respiratory disorder where HCO3 is abnormal,
determine the expected HCO3 for a chronic respiratory disorder.
@ samaresh
Stepwise approach to Acid Base
analysis
EXAMPLE:
alkalosis.
@ samaresh
Stepwise approach to Acid Base
analysis
PCO2 = 23 mm Hg, pH = 7.54, and the HCO3 = 37 mEq/L.
Chr. Resp. Alk expected HCO3 = 24 + 0.4 ×(40 – 23) = 31
mEq/L.
@ samaresh
• ----- XXXX Diagnostics ------
• Calculated Data
30 year old female with
• HCO3 act 22 sudden onset of
mmol / L
dyspnea.
• O2 Sat 98.3 %
• pO2 (A - a) 8 mm Hg
• pO2 (a / A) 0.93
No Cough or Chest
Pain
• Entered Data
• FiO2 21.0 %
Vitals normal but RR
@ samaresh
26,
anxious.
• ----- XXXX Diagnostics ------
• Calculated Data
• HCO3 act 35.1 mmol / L 60 year old male
smoker
• O2 Sat 78% with progressive
• pO2 (A - a) 9.5 mm Hg
• pO2 (a / A) 0.83 respiratory distress
and somnolence.
• Entered Data
• FiO2 21 %
@ samaresh
• ----- XXXX Diagnostics ------
@ samaresh
@ samaresh
@ samaresh